Aims: Many websites provide a medium for individuals to freely share their experiences and knowledge about different drugs. Such user-generated content can be used as a rich data source to study emerging drug use practices and trends. The study aims to examine web-based reports of loperamide use practices among non-medical opioid users. Loperamide, a piperidine derivative, is an opioid agonist approved for the control of diarrhea symptoms. Because of its general inability to cross the blood-brain barrier, it is considered to have no abuse potential and is available without a prescription. Methods: A website that allows free discussion of illicit drugs and is accessible for public viewing was selected for analysis. Web-forum posts were retrieved using Web Crawlers and retained in an Informal Text Database. All unique user names were anonymized. The database was queried to extract posts with a mention of loperamide and relevant brand/slang terms. Over 1200 posts were identified and entered into NVivo to assist with consistent application of codes related to the reasons, dosage, and effects of loperamide use. Results: Since the first post in 2005, there was a substantial rise in discussions related to its use by non-medical opioid users, especially in 2009-2011. Loperamide was primarily discussed as a remedy to alleviate a broad range of opiate withdrawal symptoms, and was sometimes referred to as 'poor man's methadone.' Typical doses frequently ranged from 100 mg to 200 mg per day, much higher than an indicated dose of 16 mg per day. Conclusions: This study suggests that loperamide is being used extra-medically by people who are involved with the abuse of opioids to control withdrawal symptoms. There is a growing demand among people who are opioid dependent for drugs to control withdrawal symptoms, and loperamide appears to fit that role. The study also highlights the potential of the Web as a 'leading edge' data source in identifying emerging drug use practices.

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Presented at The College on Problems of Drug Dependence, Palm Springs, CA, June 9-14, 2012.